Cuidado especializado em saúde mental: a integração entre a Psicologia e a Rede de Atenção Psicossocial (RAPS)

Abstract

The psychology clinic is responsible for providing regular specialized support to patients in the Unified Health System (SUS). The World Health Organization indicates that between 35% and 50% of people with mental disorders in high-income countries, and between 76% and 90% in low- and middle-income countries, do not receive adequate treatment, highlighting a gap in mental health care. Furthermore, studies on the role of psychologists in this field are limited. This research aimed to analyze the experience of structuring psychological practices in the outpatient context, developed in one of the care units of the State University of Rio de Janeiro, the Mental Health and Psychology Center at the Piquet Carneiro Polyclinic, investigating the role of the mental health clinic in its integration with the Psychosocial Care Network. During the research, one phase of the study employed a quantitative approach, using a census conducted at a mental health clinic. Data were collected from psychologists' schedules and spreadsheets to describe the practices carried out in the specialized clinic. The research, exploratory, retrospective, cross-sectional, documentary, and quantitative in nature, began in 2019, analyzing the schedules of psychologists who provided care in 2017. The sample consisted of 252 patients, with data collected from schedules, follow-up spreadsheets, and medical records. Indicators were developed to assess the care provided, and statistical analysis employed chi-square tests and t-tests for mean differences. The qualitative phase of the study involved interviews with 16 psychologists, aiming to analyze their perceptions of the care provided, therapeutic plans, psychotherapeutic approaches and techniques used, psychosocial care practices, their integration with the Psychosocial Care Network, and the challenges faced. The quantitative phase identified that 46% of patients discontinued psychotherapy, 38% continued treatment, 15% were discharged, and 1% was referred to other services. Indicators such as "absences" and poor "therapeutic plan qualification" were statistically significantly associated with treatment discontinuation. On the other hand, for the outcome "discharge," a significant association was observed between lower severity of psychiatric diagnosis, a higher number of consultations, and a lower proportion of absences. The average number of consultations for discharged patients was 7.2. These analyses support trends described in the literature regarding the relevance of studying scheduling patterns, absence rates at the first consultation, treatment discontinuation, and the characteristics of psychological care in public health services. The qualitative phase revealed differences between user engagement and the quality of care in the Unified Health System (SUS) compared to private care. Severe levels of mental illness were observed, exacerbated by difficulties in accessing treatment. The social vulnerability of patients was identified as the main challenge faced in the SUS clinic, highlighting the need for specific training to address this context.